Factors Associated with Mortality in Patients with Decubitus Ulcers Treated with Negative Pressure Wound Therapy

• Main Authors: Pınar TOSUN TAŞAR, Ömer KARAŞAHİN, Özge TİMUR, Can SEVİNÇ
• Format: Article
• Language: English
• Published: Bilimsel Tip Yayinevi 2019-12-01
• Series: Flora Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi
• Subjects: decubitus ulcer; mortality; negative pressure wound therapy
• Online Access: http://www.floradergisi.org/getFileContent.aspx?op=REDPDF&file_name=2019-24-04-377-383.pdf

Introduction: Decubitus ulcer is a common geriatric syndrome encountered in patients receiving palliative care support. Negative pressure wound therapy is one of the methods used to promote wound healing. The aim of this study was to determine factors associated with mortality in patients with decubitus ulcer treated with negative pressure wound therapy in our palliative care unit. Materials and Methods: Data from patients who were admitted to the palliative care unit for follow-up and who underwent negative pressure wound therapy due to decubitus ulcer were retrospectively evaluated. Categorical data were compared using chi-square test, and continuous data were compared using nonparametric Kruskal-Wallis and Mann-Whitney U tests. A Cox regression model was created including presence of microbiological response, presence of polymicrobial agent, presence of agent in initial wound culture, concurrent bacteremia, final C-reactive protein (CRP), final albumin, and final leukocyte counts. Results: The study included 53 palliative care patients. Their mean age was 73.6 ± 17.3 years and 33 (62.3%) were females. Bacterial growth was detected in 39 (73.6%) of the wound site cultures obtained before treating decubitus ulcers with negative-pressure wound dressing. Multiple microorganisms were isolated in 17 (47.2%) of the positive cultures. Escherichia coli was the most common isolate (39.2%). Twenty-five (47.2%) patients died and 28 (52.8%) could be discharged. Positive culture before negative pressure wound therapy was associated with statistically higher mortality rate. A Cox regression model using the variables that differed significantly between the deceased and surviving patients (microbiological response, polymicrobial infection, agent detected in initial wound culture, concurrent bacteremia, and final CRP, albumin, and leukocyte counts) showed that the presence of multiple microorganisms in decubitis ulcer increased mortality by 3.793 fold and was an independent risk factor for mortality. Conclusion: In patients with decubitus ulcer treated with negative pressure wound therapy, the presence of pre-negative pressure wound therapy hypoalbuminemia, positive wound culture, and isolation of multiple agents are independent risk factors associated with higher mortality.